Comparisons of abdominal wall reconstruction for ventral hernia repairs, open versus robotic.

The surgical complexities of our current population have pushed the technological limits of healthcare, urging for minimally invasive approaches. For ventral hernias, in particular, robotic assisted laparoscopic repairs have been met with conflict. Cost and longer operative times are among the arguments against robotic surgery, although thorough evaluation of patient outcomes could potentially advocate for use of this tool. We attempted to approach this by retrospectively reviewing our own data. We reviewed charts between September 2016 and February 2017 of patients receiving complex hernia repairs, either a standard open repair (SOR) or robotic-assisted repair (RAR). Data collected included preoperative, perioperative, and postoperative care. Of the 43 patients reviewed, 16 were SOR, versus 27 RAR. Patients were comparable in age, gender, BMI, diabetes as a comorbidity; average hernia defect size was similar between the two groups. Although operative times were longer in the RAR group, estimated blood loss (EBL) was less. Hospital stay was also shorter in the RAR group, at 3.0 ± 1.9 days versus 9.6 ± 8.4 days for the OAR group. Of those requiring critical care management, only one patient had a robotic assisted repair, versus half of the patients who received an open repair. Of the patients who presented to the emergency department within 30 days of surgery, each group had four patients, and two from the OAR group required admission. Our data is consistent with other literature supporting shorter lengths of stays. Although the robotic approach did required a longer operative time, the resulting improved patient outcomes support this technique for complex ventral hernia repairs.

Assessing Medical Student's Ability to Interpret Traumatic Injuries on Computed Tomography Before and After the Third Year Clerkships.

INTRODUCTION: Exposure to radiologic images during clinical rotations may improve students' skill levels. This study aimed to quantify the improvement in radiographic interpretation of life-threatening traumatic injuries gained during third year clinical clerkships (MS-3). METHODS: We used a paired-sample prospective study design to compare students' accuracy in reading computed tomography (CT) images at the beginning of their third year clerkships (Phase I) and again after completion of all of their third year clerkships (Phase II). Students were shown life-threatening injuries that included head, chest, abdomen, and pelvic injuries. Overall scores for Phase II were compared with Phase I, as well as sub-scores for each anatomical region: head, chest, abdomen, and pelvis. RESULTS: Only scores from students participating in both Phase I and Phase II (N = 57) were used in the analysis. After completing their MS3 clerkship, students scored significantly better overall and in every anatomical region. Phase I and Phase II overall mean scores were 1.2 ± 1.1 vs. 4.6 ± 1.8 (p < 0.001). Students improved the most with respect to injuries of the head and chest and the area of least improvement was in interpreting CT scans of the abdomen. Although improvements in reading radiographic images were noted after the clerkship year, students accurately diagnosed only 46% of life-threatening images on CT scan in the trauma setting. CONCLUSIONS: These results indicated that enhanced education is needed for medical students to interpret CT scans.

Comparisons of Medical Student Knowledge Regarding Life-Threatening CT Images Before and After Clinical Experience.

BACKGROUND: Currently, no national standard exists for educating medical students regarding radiography or formal research indicating the level of improvement regarding computed tomography (CT) interpretation of medical students during clinical rotations. METHODS: Students were evaluated based on their response to twenty-two open-ended questions regarding diagnosis and treatment of eleven de-identified CT images of life-threatening injuries. The number of incorrect answers was compared with correct or partially correct answers between students starting third-year clinical rotations and those starting their fourth year. RESULTS: Survey results were collected from 65 of 65 (100%) beginning third-year students and 9 of 60 (15%) beginning fourth-year students. Students in their fourth-year had less incorrect answers compared to third-year students, with five questions reflecting a statistically significant reduction in incorrect responses. The image with the least incorrect for both groups was epidural hemorrhage, 33.9% and 18.5% incorrect for third-year students for diagnosis and treatment, respectively, and 11.1% and 0% incorrect for fourth-year students. Outside of this image, the range of incorrect answers for third-year students was 75.4% to 100% and 44.4% to 100% for fourth-year students. CONCLUSION: Baseline CT knowledge of medical students, regardless of clinical experience, indicated a strong deficit, as more students were incorrect than correct for the majority of CT images.